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Medical Coding News Archives

Rule Proposes Unique Health Plan and Other Entity Identifiers

April 27, 2012:

Karen Kachur, RN, CPC, Clinical/Technical Editor

A unique health plan identifier (HPID) that is one of the administrative simplification provisions of the Affordable Care Act is the subject of a proposed rule published in the April 17, 2012, Federal Register. This rule would also implement a data element to apply as an “other entity” identifier (OEID) for entities needing to be identified in standard transactions that are not health plans, health care providers, or individuals.

Currently, health plans are identified in standard transactions by the use of multiple identifiers differing in length and format. This current system hinders patient eligibility determinations and transaction routing, and leads to insurance identification errors, all of which can cause rejected transactions.

One of the recommendations made by the National Committee on Vital and Health Statistics (NCVHS) subcommittee on standards for unique health plan identifiers sent to the secretary of the Department of Health and Human Services (HHS) is a proposal to establish an identifier for entities that are not health plans but perform some of the functions of health plans. Examples of such entities include health care clearinghouses, transaction vendors, third-party administrators (TPAs), and repricers. Currently, these entities are identified in the standard transactions in the same fields with the same types of identifiers as health plans. However, since they are not health plans, these entities are not able to acquire a health plan identifier. For this reason, an “other entity” identifier (OEID) has been proposed. Although not required for these other entities, use would be encouraged to foster standardization and decrease inefficiencies.

Once finalized, the regulation would become effective October 1, 2012. In accordance with the Affordable Care Act, the majority of covered entities would be required to be in compliance with the HPID effective October 1, 2014. Small health plans would be required to be in compliance effective October 1, 2015.